The fundamental and unifying hypothesis in the Emory Alcohol and Lung Biology Center competitive renewal is that chronic alcohol abuse causes oxidant stress and disrupts normal regulatory pathways, thereby producing an "alcoholic lung phenotype" that is highly susceptible to respiratory infections, acute lung injury, and other serious lung diseases. Despite modern neonatal intensive care, chronic lung injury in the premature newborn, known as bronchopulmonary dysplasia (BPD) causes significant morbidity and mortality. Late onset sepsis (LOS) in the premature newborn is linked to the development of BPD. The hypothesized shift in the signaling balance between excessive transforming growth factor-beta 1 (TGFpl) and diminished granulocyte macrophage-colony stimulating factor (GM-CSF) in the "alcoholic lung" at risk for adult respiratory distress syndrome and infection is a central theme to investigations within the Emory Alcohol and Lung Biology Center. The risk of lung injury for the newborn, particularly the premature newborn, exposed to alcohol in utero has received little attention. We have compelling evidence from pre-clinical animal models and clinical human studies that in utero alcohol exposure increased oxidant stress in the neonatal lung, increased TGFpl and decreased GM-CSF in the developing airway. We have demonstrated dysfunction of the fetal alcohol-exposed animal alveolar macrophage while human clinical data suggested an increased the risk of BPD and sepsis for the alcohol-exposed premature newborn. We hypothesize that increased pulmonary oxidant stress in the premature newborn exposed to alcohol in utero shifts the signaling balance towards excessive TGFj3i and diminished GM-CSF, resulting in AM dysfunction and an increased risk of BPD and LOS. We will extend this hypothesis to the clinical arena of the neonatal intensive care unit in this new Project within the Emory Alcohol and Lung Biology Center. Within our unique network of researchers, we have the novel opportunity to address these vitally important and as of yet unanswered questions for the human premature newborn. With the expertise of the Clinical Core, we will prospectively identify the alcohol-exposed premature newborn and evaluate fatty acid ethyl esters as a potential biomarker of prenatal alcohol exposure. Interactions with Center investigators will catalyze translational studies identifying biochemical biomarkers of this exposure in the premature lung, determining alcohol's effect on premature human alveolar macrophage, and ultimately defining the risks of bronchopulmonary dysplasia and late onset sepsis in the alcohol-exposed premature newborn infant. These studies will provide a firm foundation for future investigations aimed at the development of potential therapeutic interventions for our tiniest at-risk patients.